Interactive Navigation-Guided Ophthalmic Plastic Surgery: The Usefulness of Computed Tomography Angiographic Image Guidance.

Objective: The aim of this study was to illustrate the techniques and usefulness of navigation-guided computed tomography angiography in ophthalmic plastic surgery.

Methods: Stereotactic surgeries using computed tomography angiography as the intraoperative image-guiding tool were performed in 3 patients. One patient had widespread eyelid and orbital vascular malformation and the other 2 had orbital mass lesions located in crucial vascular areas. Two procedures used the external approach and one was performed using the endoscopic orbital approach. All the surgeries were performed using the intraoperative image-guided StealthStation system in the electromagnetic mode. The usefulness of intraoperative angiographic anatomical guidance and the ability to anticipate and avoid vascular injuries at crucial phases of surgery were noted.

Results: Intraoperative geometric localization of feeder vessels to a lesion could be easily achieved. The cauterization of the direct feeder to the lesion reduced the much anticipated blood loss while operating a widespread vascular malformation. Orbital mass lesions with vessels in the vicinity could be operated upon with utmost vascular safety and precision, thereby avoiding complications. Detailed preoperative navigation-guided planning of risk structures with intraoperative distance control was found to be essential for successful outcomes.

Conclusions: Computed tomography angiography-guided navigation surgery is very useful in cases with complex vascular malformations and while operating in the vicinity of crucial vascular structures in the orbit.